Subtitles and Transcript

Erica Frenkel

0:15
I'm going to talk to you todayabout the design of medical technology for low resource settings.I study health systems in these countries.And one of the major gaps in care,almost across the board,is access to safe surgery.Now one of the major bottlenecks that we've foundthat's sort of preventing both the access in the first placeand the safety of those surgeries that do happenis anesthesia.And actually, it's the model that we expect to workfor delivering anesthesiain these environments.

0:44
Here we have a scene that you would findin any operating room across the U.S. or any other developed country.In the background thereis a very sophisticated anesthesia machine.And this machine is ableto enable surgery and save livesbecause it was designedwith this environment in mind.In order to operate, this machine needs a number of thingsthat this hospital has to offer.It needs an extremely well-trained anesthesiologistwith years of training with complex machinesto help her monitor the flows of the gasand keep her patients safe and anesthetizedthroughout the surgery.It's a delicate machine running on computer algorithms,and it needs special care, TLC, to keep it up and running,and it's going to break pretty easily.And when it does, it needs a team of biomedical engineerswho understand its complexities,can fix it, can source the partsand keep it saving lives.

1:35
It's a pretty expensive machine.It needs a hospitalwhose budget can allow it to support one machinecosting upwards of 50 or $100,000.And perhaps most obviously,and perhaps most importantly --and the path to concepts that we've heard aboutkind of illustrate this --it needs infrastructurethat can supply an uninterrupted sourceof electricity, of compressed oxygenand other medical suppliesthat are so critical to the functioningof this machine.In other words, this machine requires a lot of stuffthat this hospital cannot offer.

2:10
This is the electrical supplyfor a hospital in rural Malawi.In this hospital,there is one person qualified to deliver anesthesia,and she's qualifiedbecause she has 12, maybe 18 monthsof training in anesthesia.In the hospital and in the entire regionthere's not a single biomedical engineer.So when this machine breaks,the machines they have to work with break,they've got to try and figure it out, but most of the time, that's the end of the road.Those machines go the proverbial junkyard.And the price tag of the machine that I mentionedcould represent maybe a quarter or a thirdof the annual operating budgetfor this hospital.

2:47
And finally, I think you can see that infrastructure is not very strong.This hospital is connected to a very weak power grid,one that goes down frequently.So it runs frequently, the entire hospital,just on a generator.And you can imagine, the generator breaks downor runs out of fuel.And the World Bank sees thisand estimates that a hospital in this setting in a low-income countrycan expect up to 18 power outagesper month.Similarly compressed oxygen and other medical suppliesare really a luxuryand can often be out of stockfor months or even a year.

3:21
So it seems crazy, but the model that we have right nowis taking those machinesthat were designed for that first environment that I showed youand donating or selling themto hospitals in this environment.It's not just inappropriate,it becomes really unsafe.

3:38
One of our partners at Johns Hopkinswas observing surgeries in Sierra Leoneabout a year ago.And the first surgery of the day happened to be an obstetrical case.A woman came in, she needed an emergency C-sectionto save her life and the life of her baby.And everything began pretty auspiciously.The surgeon was on call and scrubbed in.The nurse was there.She was able to anesthetize her quickly,and it was important because of the emergency nature of the situation.And everything began welluntil the power went out.And now in the middle of this surgery,the surgeon is racing against the clock to finish his case,which he can do -- he's got a headlamp.But the nurse is literallyrunning around a darkened operating theatertrying to find anything she can use to anesthetize her patient,to keep her patient asleep.Because her machine doesn't work when there's no power.And now this routine surgery that many of you have probably experienced,and others are probably the product of,has now become a tragedy.And what's so frustrating is this is not a singular event;this happens across the developing world.35 million surgeries are attempted every yearwithout safe anesthesia.

4:48
My colleague, Dr. Paul Fenton,was living this reality.He was the chief of anesthesiologyin a hospital in Malawi, a teaching hospital.He went to work every dayin an operating theater like this one,trying to deliver anesthesia and teach others how to do sousing that same equipmentthat became so unreliable, and frankly unsafe,in his hospital.And after umpteen surgeriesand, you can imagine, really unspeakable tragedy,he just said, "That's it. I'm done. That's enough.There has to be something better."So he took a walk down the hallto where they threw all those machines that had just crapped out on them --I think that's the scientific term --and he just started tinkering.He took one part from here and another from there,and he tried to come up with a machinethat would work in the reality that he was facing.

5:33
And what he came up with was this guy,the prototype for the Universal Anesthesia Machine --a machine that would workand anesthetize his patientsno matter the circumstances that his hospital had to offer.Here it is back at homeat that same hospital, developed a little further, 12 years later,working on patients from pediatrics to geriatrics.

5:55
Now let me show you a little bit about how this machine works.Voila!Here she is.When you have electricity,everything in this machine begins in the base.There's a built-in oxygen concentrator down there.Now you've heard me mention oxygen a few times at this point.Essentially, to deliver anesthesia,you want as pure oxygen as possible,because eventually you're going to dilute it essentiallywith the gas.And the mixture that the patient inhalesneeds to be at least a certain percentage oxygenor else it can become dangerous.But so in here when there's electricity,the oxygen concentrator takes in room air.Now we know room air is gloriously free,it is abundant,and it's already 21 percent oxygen.So all this concentrator does is take that room air in, filter itand send 95 percent pure oxygenup and across herewhere it mixes with the anesthetic agent.

6:48
Now before that mixturehits the patient's lungs,it's going to pass by here --you can't see it, but there's an oxygen sensor here --that's going to read out on this screenthe percentage of oxygen being delivered.Now if you don't have power,or, God forbid, the power cuts out in the middle of surgery,this machine transitions automatically,without even having to touch it,to drawing in room air from this inlet.

7:13
Everything else is the same.The only difference is that nowyou're only working with 21 percent oxygen.Now that used to be a dangerous guessing game,because you only knew if you had given too little oxygen once something bad happened.But we've put a long-life battery backup on here.This is the only part that's battery backed up.But this gives control to the provider,whether there's power or not,because they can adjust the flowbased on the percentage of oxygen they see that they're giving their patient.

7:40
In both cases,whether you have power or not,sometimes the patient needs help breathing.It's just a reality of anesthesia. The lungs can be paralyzed.And so we've just added this manual bellows.We've seen surgeries for three or four hoursto ventilate the patient on this.

7:57
So it's a straightforward machine.I shudder to say simple;it's straightforward.And it's by design.And you do not need to bea highly trained, specialized anesthesiologist to use this machine,which is good because, in these rural district hospitals,you're not going to get that level of training.It's also designed for the environment that it will be used in.

8:20
This is an incredibly rugged machine.It has to stand upto the heat and the wear and tear that happensin hospitals in these rural districts.And so it's not going to break very easily,but if it does, virtually every piece in this machinecan be swapped out and replacedwith a hex wrench and a screwdriver.And finally, it's affordable.This machine comes inat an eighth of the costof the conventional machine that I showed you earlier.So in other words, what we have hereis a machine that can enable surgery and save livesbecause it was designed for its environment,just like the first machine I showed you.

9:00
But we're not content to stop there.Is it working?Is this the design that's going to work in place?Well we've seen good results so far.This is in 13 hospitals in four countries,and since 2010,we've done well over 2,000 surgerieswith no clinically adverse events.So we're thrilled.This really seems like a cost-effective, scalable solutionto a problem that's really pervasive.But we still want to be surethat this is the most effective and safe devicethat we can be putting into hospitals.

9:32
So to do that we've launched a number of partnershipswith NGOs and universitiesto gather data on the user interface,on the types of surgeries it's appropriate forand ways we can enhance the device itself.One of those partnershipsis with Johns Hopkins just here in Baltimore.They have a really cool anesthesia simulation lab out in Baltimore.So we're taking this machineand recreating some of the operating theater crisesthat this machine might facein one of the hospitals that it's intended for,and in a contained, safe environment,evaluating its effectiveness.We're then able to compare the results from that studywith real world experience,because we're putting two of these in hospitalsthat Johns Hopkins works with in Sierra Leone,including the hospital where that emergency C-section happened.

10:20
So I've talked a lot about anesthesia, and I tend to do that.I think it is incredibly fascinatingand an important component of health.And it really seems peripheral, we never think about it,until we don't have access to it,and then it becomes a gatekeeper.Who gets surgery and who doesn't?Who gets safe surgery and who doesn't?But you know, it's just one of so many waysthat design, appropriate design,can have an impact on health outcomes.If more people in the health delivery spacereally working on some of these challenges in low-income countriescould start their design process,their solution search,from outside of that proverbial boxand inside of the hospital --in other words, if we could designfor the environment that exists in so many parts of the world,rather than the one that we wished existed --we might just save a lot of lives.